Sewing a smile onto the face of despair

Nicholas read, special to the sun07.27.2013

Langara journalism professor and former Vancouver Sun reporter Nicholas Read, centre, has suffered from depression. He received help for his condition from Dr. Leonardo Silveira, left, and Dr. David Bond.

The first day was the worst. It was evening, already dark, and I was dressed in a pair of hospital-issue, many-times-washed, pale yellow pyjamas and beige, skid-proof socks with white happy faces embossed on both sides. (Either someone’s idea of a cruel joke or a completely misplaced attempt at fostering high spirits by literally sewing a smile onto a sickness).

I was at the communal phone of the University of B.C. Hospital Mood Disorders Unit, trying to reach a friend to tell him that after being examined in the Vancouver General Hospital psychiatric assessment unit, I had been transferred back to UBC for a stay of yet-to-be-determined length and treatment.

In other words, I was in what my father called “the nut house” 42 years earlier when he was admitted after attempting suicide, or what Ken Kesey famously dubbed “the cuckoo’s nest” in his 1962 novel about an Oregon mental hospital. And for better or worse, I wasn’t about to leave any time soon.

All my belongings, including my clothes, had been locked away in a cupboard, and the key had been removed by the unit’s nurses. Had I harboured any notions of escape, I wouldn’t have got far. (Another resident who tried several days later was brought back in handcuffs.)

According to Dr. David Bond, one of my attending psychiatrists and a clinical assistant professor of psychiatry at the unit, that’s done for safety reasons. “When someone is first admitted, we don’t know them well,” Dr. Bond said of the protocol. “We do admit a fraction of patients who are acutely suicidal or manic, and it’s difficult to tell in the first few hours who is at risk of making a suicide attempt or being dangerous in another way.”

The Mood Disorders Unit, located on the ground floor of a Stalinist-style block of concrete on Wesbrook Mall at UBC, is a 15-bed psychiatric in-patient unit, staffed by psychiatrists and other health professionals including nurses, psychologists, pharmacists, social workers and occupational therapists, that specializes in the assessment, treatment and research of mood disorders such as major depression and bipolar disorder. It is the only in-patient unit of its kind in B.C.

I was in for the former, depression. I’d had my first panic attack about a year-and-a-half earlier, but it wasn’t until Christmas 2012 that I’d begun to suffer what turned out to be truly incapacitating anxiety and depression. By mid-April, I was a basket case. I simply couldn’t function. A program of antidepressants prescribed to me by my GP and a psychiatrist at the Mood Disorders Association of B.C., an outpatient clinic on Nanaimo Street, wasn’t working — and neither was I.

My panic caused me to hyperventilate constantly. I could barely utter a word without crying — more like convulsive sobbing — and I was wound up like a clock. I had no interest in anything, even in things I ordinarily got excited about, and I wasn’t comfortable anywhere except in bed.

I didn’t have to sleep; just lying there was enough. Getting up became a herculean effort. The hardest thing I did all day.

Why? No one really knows. Medicine’s best guess is some sort of biochemical imbalance or breakdown brought on by genetics, physiology, psychological trauma and even stress that at its worst can knock a victim cold. It certainly did me. According to Health Canada, as many as one in seven people will suffer from a mood disorder at some point in his or her life, but most won’t be severe enough to warrant a stay at UBC.

The mood disorders unit is only for people with a major depressive or the manic phase of bipolar disorder. That is, people at the most severe end of the severity spectrum — about 150 patients per year. It also operates an outpatient clinic in which anywhere from 500 to 600 people are assessed each year by the clinic’s doctors and then discharged with a prescribed treatment to the care of their GPs.

I got in at the urging of a doctor in a walk-in clinic. He said my symptoms were such that I should talk to my GP about getting admitted to hospital as soon as possible. But as it was a Sunday, I decided to go directly to UBC’s emergency ward myself. Within an hour, I was in. After that I was taken to VGH for further assessment and then back to UBC where I remained until my discharge just over a month later.

Everyone shares a bedroom with another person in the unit. During my first night there I was placed in a room with a young man who barely spoke. What he did do was get up just before 6 a.m. to place — or replace — all his belongings in meticulous order in drawers and on tabletops. When he was discharged, my new roommate, who remained with me for the rest of my stay, would wake in the middle of the night, turn his overhead light on and have dinner, saying he never got hungry till then.

One night, rather than using the men’s washroom two doors down the hall, he chose to pee into an old tin can, which he then kept on the room’s heating register. Later, I found the can in the sink where I brushed my teeth. I never used that sink again.

Treatment at the centre varies from patient to patient, but generally speaking it consists of a combination of drug and talk therapy. Consultations about the former take place with psychiatrists and the latter with a psychologist. Social workers and occupational therapists are also available to help address the long-term consequences that many people with mood disorders experience, such as unemployment, financial problems and marital and family discord.

My treatment consisted of daily meetings with Dr. Bond and his colleague, Dr. Leonardo Silveira, an occasional visit with a psychologist, and twice- or even thrice-daily tête-à-têtes with the unit’s nurses, who are there around the clock. Each day as they dispensed pills, they asked me to score my mood on a scale of one to 10, and if I felt like harming myself or someone else. I never did, but I often wanted to disappear. I say this with the utmost sincerity. What I wanted was to be gone and done with the whole business of living, forever. This, I suppose, was as feebly close to a suicide threat as I ever made.

Drugs were doled out regularly and in significant quantities throughout my stay. During my first week, I wobbled around on at least half a dozen tranquillizers each day. Twice I fell into the same flower bed while trying to navigate my way around the building’s main entrance.

It was during this week that Bond and Silveira worked to identify a suitable drug for me. They finally settled on something called Quetiapine, which I began taking daily in Week 2. (I still take it. It’s the linchpin of my treatment.) After that, they watched, monitored and waited to see if it would take effect the way they hoped. However, as that wasn’t expected to happen for weeks, it left me with a lot of time to kill.

Surprisingly, that wasn’t hard. Friends kindly lent me a radio, an iPad loaded with Bewitched and I Love Lucy reruns and a headset, since reading, ordinarily one of my favourite pursuits, was beyond my capability. My concentration, or lack thereof, wouldn’t permit it. The most I could manage was the occasional magazine, provided it had a lot of pictures.

There was also television (the unit has three screens), a sort of playroom with a ping-pong table and jigsaw puzzles, a painting area (my roommate turned out to be a fairly fine artist), and a kitchenette for making tea and coffee.

Once the treatment team was convinced I wasn’t at risk of harming myself, I was allowed out for spring walks on the UBC campus, and had frequent visitors. So slowly and perniciously, the unit became strangely homelike. Perniciously, because getting too comfortable in it can be an impediment to a patient’s recovery. Simply put, you don’t want to leave. I didn’t. The fact was I got used to the place — even a little fond of it. And if that sounds peculiar, it isn’t.

Doctors say patients often get attached to the place in a way that makes going home difficult. When it was my turn, I was so upset, I couldn’t say goodbye.

The fact that it doesn’t look like a hospital ward helps. There are wood beams and panels here and there that evoke a very large, very odd cabin. Paintings, mainly of landscapes and other soothing scenes of nature, hang everywhere. The desired effect is as obvious as a lullaby, but it works. It’s pleasant in the way it’s intended to be. You know you’re in a hospital and yet it doesn’t feel exactly like one.

Some patients walk around in pyjamas. Others wear street clothes. It depends on how they’ve been assessed and whether they’re considered a danger to themselves or other people. Some are allowed out on their own (I was, but I always had to sign out on a white board and let my nurses know where I was going and for how long) while others had to be accompanied by a member of staff. Group outings led by the psychologist, the occupational therapist or a nurse are common.

Weekend passes are also given under certain circumstances. I had one two weeks into my stay. I was allowed Friday and Saturday nights at home, but was expected back Sunday at dinnertime. You might think it was a godsend, but you’d be wrong. It was terrifying. After spending all my time in an environment where everything was controlled and ordered, reintroducing myself to independence and the catch-as-catch-can of everyday living was like being sent, à la Star Trek, to another dimension. A place where everything was familiar, but also threatening. The noise, the crowds, the constant movement. All were fodder for panic first, then depression. By Saturday evening, I was in full fetal retreat, curled up in a cocoon on one end of my sofa, nursing a glass of red wine (now that was a treat) and wishing for Sunday.

But this, it turns out, is also typical of mood disorder patients, and is something the unit’s doctors struggle with constantly. The fact is you feel safe in hospital. You feel looked after. You’re still cognizant of its many deprivations, but you feel part of something cohesive and comforting. A machine with all its parts. At home you don’t. You feel vulnerable, incapable and alone, even when you’re not.

Thus after four-and-a-half weeks, the words “hospital discharge” caused me more angst than joy. How would I cope? Where would I go, and what would I do when things went wrong? On one level, it seemed ludicrous, especially after the first-night over-washed pyjamas, ridiculous socks and creeping fog of TV otherworldliness. But humans are adaptable, and we all like care and attention. I loved my nurses. My doctors, too. So it was terrifying to contemplate leaving them and looking after myself.

But that’s how the unit works. It doesn’t make you well; it puts you in a position where, thanks to the drugs you’re prescribed and the behavioural therapies you may have learned, you can get well later. The drugs may take weeks to work and modified behaviour requires a lot of practice to be effective. So you can bet on a lot of tough days ahead. But at least a treatment plan has been put in place.

That’s certainly how it worked for me. Little by little, I am getting better. Initially, a team of home-based treatment clinicians (nurses and therapists) visited for three weeks after my discharge. They shepherded me along with helpful advice, behavioural modification tips and, when I needed it, some hand-holding. They scolded me, too. None shook a finger, but they came close.

What they were, it turned out, were an alternative to staying longer in hospital. The idea was that while I may have been well enough to leave the ward, I wasn’t well enough to do it without help. It was like riding a bicycle with training wheels. I may have thought I’d learned how to balance things, but if those wheels hadn’t been there, I’d have tipped over for sure. No wonder I wept oceans when the team made its last visit.

Today, the journey still isn’t over. Most likely it never will be. My doctors tell me I probably will have to take medication forever, and even then, there’s a chance that bouts of illness will recur. If they do, they should be shorter and less punishing, but there’s no guarantee. Certainly there have been days since leaving the hospital when I felt very much the same as I did before entering it.

But when you consider what a mystery a healthy brain is, it’s small wonder that an unhealthy one presents clinicians with such a formidable challenge. Or as Dr. Bond put it: “Neuroscience is only beginning to understand the normal brain. So to understand psychiatric illness is a great black box.”

That’s why the UBC clinic, in keeping with its scholarly surroundings, is also a place of research. At any one time, any number of clinical and pharmacological trials are being conducted on its premises. During my stay, I volunteered to take part in a trial designed to figure out exactly how and where Quetiapine acts on the brain.

It was the least I could do to say thank you. After all, the place and the people who work there did save my life, the oft-washed pyjamas, happy-face socks and urine-stained tin cans notwithstanding.

Nicholas Read teaches journalism at Langara College and is the author of several children’s books, the most recent of which is City Critters: Wildlife in the Urban Jungle.

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